Many folks living in southern Nevada rely on Medicare coverage for pain management solutions. Medicare has long paid for traditional options like prescription medications. Recently, however, Original Medicare has expanded coverage to include acupuncture for some patients. Even if you don’t get qualify through Original Medicare, other insurance may support your acupuncture treatments.
How Original Medicare Approaches Acupuncture
The Centers for Medicare & Medicaid Services (CMS) confirmed in January 2020 that Medicare Part B will cover some acupuncture for people with chronic low back pain. The CMS explained its decision by saying it had a mandate to offer different pain treatment options to patients. These include alternatives to prescription pain medications.
Acupuncture Services Covered by Medicare
Original Medicare does not yet cover acupuncture for everyone or for any type of chronic pain. Medicare pays only for people who live with chronic low back pain. This is defined as pain without a systemic cause, and must not be connected to surgery or pregnancy. The pain must have lasted for 12 weeks or longer.
Also, you must receive this therapy from a healthcare provider with advanced training in acupuncture or Oriental Medicine. The provider must also have a license to perform acupuncture in your state.
If all of these conditions are met, Medicare will cover 12 acupuncture appointments within 90 days, with an additional 8 covered within that time if your condition gets better. These additional appointments are not paid for by Medicare if your doctor does not think the treatment is improving your back pain.
Medicare Part B pays for up to a maximum of 20 acupuncture visits per year.
Acupuncture Coverage with Medicare Advantage Plans (Part C)
Medicare Advantage plans offer additional coverage for services not covered by Original Medicare. What’s exactly covered depends on the Medicare Advantage plan you choose. These are offered by private insurers whose terms vary. Most Medicare Part C plans offer dental and vision care, for example, and some offer additional perks like gym memberships. Some plans may therefore include expanded acupuncture coverage.
Remember, Medicare Advantage plans may only support work done by practitioners within a provider network. So once you know you can get acupuncture, review your Part C plan’s guidelines about whose services are covered. As a reminder, Medicare Advantage Plans are of four general types:
- Health maintenance organization (HMO) plans
- Special needs plans (SNPs)
- Preferred provider organization (PPO) plans
- Private fee-for-service (PFFS) plans
HMO plans usually won’t cover services by out-of-network providers except in case of emergency. PPO plans may cover services by those who are not preferred providers, but you will have to pay more out of pocket.
Your Options if Medicare Won’t Cover Your Acupuncture
Fortunately, Medicare plans can work with other insurance if you have a Medicare Supplement plan. One insurer may pay for services up to set limits, then the other insurer will pay the rest. So if no part of your Medicare plan covers your acupuncture treatment, you may be able to claim it on another insurance policy.
This might happen for a few different reasons. Perhaps your doctor recommends acupuncture for a condition other than chronic low back pain, or you have already used up the number of appointments allowed under Medicare Part B. An additional health insurance policy, such as a Medicare Supplement, may cover those acupuncture expenses.
For example, some private (non-Medicare) health insurance plans cover acupuncture for any kind of chronic pain that has lasted for six months or more, or for chemotherapy or surgery-induced nausea.
Your insurance options are in addition to any special discounts offered by individual practitioners. Of course, you should always choose any healthcare provider based on their expertise, and should feel comfortable giving them your trust. Once you have a licensed acupuncturist in mind, you can ask if they offer their own cost reductions for Medicare patients or for seniors.
How Can Intermountain Health, Help You?
Intermountain Health, has a broad network of 300 primary care providers and 1,500 specialists. Our team is committed to advancing the quality of your healthcare. We can help you understand and make the most of your Medicare coverage, while remaining dedicated first and foremost to your improved wellbeing.